Weight loss maintenance in primary care

描述(申请人提供)：肥胖率的上升正在对国家的健康造成越来越严重的损害。对于那些超重的人来说，实现并保持医学上的显著减肥尤其重要，这些人患有或最有可能患上与肥胖有关的许多医疗条件之一。本提案的目的是评估在初级保健实践中维持体重的三种治疗方法，这些患者是常规治疗的。一种治疗包括传统的生活方式改变计划(基于学习手册)。第二个包括学习计划和使用膳食代用品(MRS)，以促进减肥维持。第三项计划包括学习+MR和降低能量密度饮食计划(REDE)。这三种治疗将使用两种不同的提供计划的模式进行管理，一种是基于小组的(由外部专家领导传统的体重控制计划)，另一种是基于实践的(医生和基于实践的护理经理合作将计划提供给个别患者)。参与者将包括312名超重和肥胖的初级保健患者。所有参与者最初将通过相同的1200-1500卡路里/天的饮食(包括两个MRS和一顿健康晚餐)减肥，之后将引入三种维持干预措施之一。这项研究的第二个目的是调查体重维持结果不同的机制。最终目的是检验几种个体差异测量作为研究结果的潜在调节因素，无论是单独的还是与治疗条件结合的。这项研究很重要，因为它可能确定更好的方法来促进初级保健环境中超重患者的饮食和体重的长期改善。参与者将在一年内接受治疗，治疗结束后一年和两年将进行后续评估。结果将根据体重和成分的变化、饮食的营养成分、饮食控制措施、暴饮暴食和生活质量、体力活动、患者和医生满意度、成本效益和几个医疗风险因素(血压、血脂、空腹血糖和糖化血红蛋白)进行评估。

DESCRIPTION (provided by applicant): The rising prevalence of obesity is taking an increasingly severe toll on the nation's health. Achieving and maintaining a medically significant weight loss is of particular importance for those overweight individuals who have, or who are at greatest risk for developing, one of the many medical conditions associated with obesity. The present proposal is aimed at evaluating three treatments for weight loss maintenance in primary care practices where such patients are routinely treated. One treatment consists of a conventional lifestyle change program (based on the LEARN manual). The second consists of the LEARN program plus the use of meal replacements (MRs) to facilitate weight loss maintenance. The third consists of LEARN+MR and a Reduced Energy Density Eating program (REDE). The three treatments will be administered using two different modes of delivering the programs, one group-based (where an outside expert leads a traditional weight control program) and the other practice-based (where physicians and a practice-based care manager collaborate to deliver the program to individual patients). Participants will consist of 312 overweight and obese primary care patients. All participants will initially lose weight on identical 1,200-1,500 kcal/day diets (consisting of two MRs and a healthy dinner), after which one of the three maintenance interventions will be introduced. A second aim of the study is to investigate the mechanisms responsible for differential weight maintenance outcomes. A final aim is to examine several individual difference measures as potential moderators of study outcomes, both alone and in combination with treatment condition. This study is important because it may identify better ways of promoting long-term improvements in diet and body weight in overweight patients seen in primary care settings. Participants will receive treatment during a one-year period and follow-up assessments will be conducted one and two years after treatment ends. Outcome will be assessed in terms of changes in body weight and composition, nutritional composition of the diet, measures of eating control, overeating, and quality of life, physical activity, patient and physician satisfaction ratings, cost-effectiveness, and several medical risk factors (blood pressure, lipids, fasting glucose, and HbAlc).